Celiac – Is Your Diet Harming You?

What you don’t know can harm you – Gluten and the silent disease called Celiac

What is gluten?

A protein found in wheat, barley, rye, spelt, kamut, einkorn and other grains.

Cross-contamination can often happen with oats, too

Gives bread structure, elasticity and that characteristic chewiness

Gluten develops when glutenin and gliadin link together to form chains

The percentage of gluten in a product depends on the flour and the product. For example, cake flours have a lower percentage of protein versus an artisanal bread which contains a higher percentage of protein

Higher amounts of gluten develop with more moisture and mixing time

Symptoms

Gregory Bourolias

Celiac (also referred to as celiac sprue or coeliac) symptoms are typically different in children and adults. As of now, there are approximately 300 symptoms associated with the disease from early to late stages. Serious complications can arise from untreated celiac.

Digestive symptoms are more common in infants and children. The most common symptoms in children include abdominal bloating and pain, chronic diarrhea, vomiting, constipation, pale, foul-smelling, or fatty stool, fatigue, irritability and behavioral issues, dental enamel defects of the permanent teeth, delayed growth and puberty, short stature, failure to thrive in infants and Attention Deficit Hyperactivity Disorder (ADHD). There is a growing body of research correlating Type 1 diabetes with celiac. See this study in The New England Journal of Medicine and a range of more scientific literature here.

Symptoms in adults can be more difficult to pinpoint as digestive distress lessens with age. Some common symptoms include unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, bone loss or osteoporosis, depression or anxiety, tingling numbness in the hands and feet (aka celiac neuropathy and more in this study), migraines, missed menstrual periods, infertility or recurrent miscarriage, canker sores inside the mouth and a skin rash called dermatitis herpetiformis (DH) (see below for more information on DH).

Why Test and What are You Testing for?

Pavel Kekas

Celiac disease: Celiac is an autoimmune disease triggered by the ingestion of gluten-containing foods such as bread and pasta. Most tests are conducted whilst still eating gluten. The only test available if you have already stopped eating gluten is the genetic test. All other options require a diet containing gluten. In most of Asia there are 5 options for testing. Choose the one that is right for you.

Blood Testing: The most sensitive and best one to use is the tTG-IgA test which stands for Tissue Transglutaminase Antibodies. Take this test while you are still eating gluten. It detects 98% of patients with celiac disease who are you still eating gluten. There is a risk of a false positive especially for people with associated autoimmune disorderslike Type 1 diabetes, chronic liver disease, Hashimoto’s thyroiditis, psoriatic or rheumatoid arthritis and heart failure, who do not have celiac disease. HK Biotech offers this test in Hong Kong. (Ref: Celiac.org)

Genetic Test: People with celiac disease carry one or both of the HLA DQ2 and DQ8 genes. This test is used to rule out celiac disease when the person is already on a gluten free diet or is other tests are inconclusive. It can also be good to relay to relatives if you want them to be tested after you test positive. See the Department of Health’s Clinical Genetic Service for more information on genetic testing.

Skin Biopsy for Dermatitis Herpetiformis (DH): DH is a very itchy bumpy or blistered rash often on the forearms, near the elbows and/or on the knees and bum associated with celiac disease where antibodies are created in response to gluten collecting under the skin and create the rash. A skin biopsy can diagnose both DH and celiac disease. DH is a skin manifestation of celiac and is a. A positive skin biopsy is a definitive diagnosis. No intestinal biopsy is needed. It is especially commonly diagnosed as eczema. See a dermatologist for this procedure.

Intestinal Biopsy: A scope is inserted through the mouth and down the esophagus, stomach and small intestine. The physician should take at least four duodenal samples including at least one from the duodenal bulb. After the samples are taken, they are studied under a microscope to look for damage and inflammation characteristic of celiac disease. IMPORTANT: For biopsy results to be accurate, you must be eating gluten (at least 4 slices of bread per day) for 1-3 months prior to the procedure. Be sure to check details with your physician or gastroenterologist.

Video endoscopy: A small capsule the size of a large vitamin pill is swallowed, which then takes thousands of pictures as it travels the intestine. After the tests, your doctor will discuss results related to the ‘Marsh Stage’. The phases go from Marsh 0, meaning your intestines and villi are completely normal. Marsh II-IV corresponds with varying degrees of intestinal villi degradation. This study goes into more detail.

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